MEDICARE: RICHMOND PEDIATRIC & ADOLESCENT MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0420010554	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RICH00068256	OTHER	VT	BCBS GROUP ID #

General Provider Information

NPI Number	:	1326132416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND PEDIATRIC & ADOLESCENT MEDICINE

Provider Business Mailing Address
First Line	:	12 BURNETT CT
Second Line	:
City	:	RICHMOND
State	:	VT
Zip	:	05477-4410
Country	:	US
Telephone Number	:	802-434-5090
Fax Number	:	802-329-2144

Provider Business Practice Location Address
First Line	:	12 BURNETT CT
Second Line	:
City	:	RICHMOND
State	:	VT
Zip	:	05477-4410
Country	:	US
Telephone Number	:	802-434-5090
Fax Number	:	802-329-2144

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	PAUL J PARKER
Credential	:	MD
Telephone Number	:	802-434-5090

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/08/2010

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Directions to “RICHMOND PEDIATRIC & ADOLESCENT MEDICINE ” Practice Location

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